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. 2023 Dec 8;9(6):2211-2221.
doi: 10.3390/tomography9060171.

Chest X-ray at Emergency Admission and Potential Association with Barotrauma in Mechanically Ventilated Patients: Experience from the Italian Core of the First Pandemic Peak

Pietro Andrea Bonaffini  1   2 , Francesco Stanco  1   2 , Ludovico Dulcetta  1   2 , Giancarla Poli  3 , Paolo Brambilla  1 , Paolo Marra  1   2 , Clarissa Valle  1   2 , Ferdinando Luca Lorini  2   3 , Mirko Mazzoleni  4 , Beatrice Sonzogni  4 , Fabio Previdi  4 , Sandro Sironi  1   2
Affiliations

Chest X-ray at Emergency Admission and Potential Association with Barotrauma in Mechanically Ventilated Patients: Experience from the Italian Core of the First Pandemic Peak

Pietro Andrea Bonaffini et al. Tomography. .

Abstract

Barotrauma occurs in a significant number of patients with COVID-19 interstitial pneumonia undergoing mechanical ventilation. The aim of the current study was to investigate whether the Brixia score (BS) calculated on chest-X-rays acquired at the Emergency Room was associated with barotrauma. We retrospectively evaluated 117 SARS-CoV-2 patients presented to the Emergency Department (ED) and then admitted to the intensive care unit (ICU) for mechanical ventilation between February and April 2020. Subjects were divided into two groups according to the occurrence of barotrauma during their hospitalization. CXRs performed at ED admittance were assessed using the Brixia score. Distribution of barotrauma (pneumomediastinum, pneumothorax, subcutaneous emphysema) was identified in chest CT scans. Thirty-eight subjects (32.5%) developed barotrauma (25 pneumomediastinum, 24 pneumothorax, 24 subcutaneous emphysema). In the barotrauma group we observed higher Brixia score values compared to the non-barotrauma group (mean value 12.18 vs. 9.28), and logistic regression analysis confirmed that Brixia score is associated with the risk of barotrauma. In this work, we also evaluated the relationship between barotrauma and clinical and ventilatory parameters: SOFA score calculated at ICU admittance and number of days of non-invasive ventilation (NIV) prior to intubation emerged as other potential predictors of barotrauma.

Keywords: Brixia score; COVID-19; barotrauma; chest radiography; mechanical ventilation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Axial chest CT image of a 62-year-old male with COVID-19 pneumonia (Group 1), who developed pneumothorax (arrow), pneumomediastinum (arrowhead) and extensive subcutaneous emphysema (asterisk). The patient had a Brixia score of 14 at ER, 1 day of NIV prior to intubation and a SOFA score of 11 at ICU admission. The patient died during ICU hospitalization.
Figure 2
Figure 2
Graphic representation of the Brixia score (BS) value distribution in the two study groups: (a) Group 1—barotrauma, (b) Group 2—No barotrauma.
Figure 3
Figure 3
Frontal CXR in a 75-year-old male with SARS-CoV-2 infection, with a calculated Brixia score of 12. Days of NIV were 4 and SOFA score at ICU admission 12. The patient did not develop barotrauma and survived ICU hospitalization and acute infection.
Figure 4
Figure 4
(a) CXR of a 37-year-old woman with severe bilateral COVID-19 pneumonia (Brixia score 17; days of NIV 0; SOFA score 5). The patient was directly intubated at ER admission and after 20 days of mechanical ventilation developed left-side pneumothorax, as shown on chest CT with coronal reconstruction (arrow, (b)). The patient was alive at the end of the study period.
See this image and copyright information in PMC

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